Juvenile delinquency from medical view

Humanity has been trying to decide the problem of crimes for many centuries relying on either law wisdom and punishment severity or legal rules compliance and proper youth upbringing. It means that this problem is traditionally understood in social, psychological, and ethic aspects. But there are reasons to hope that the progress of the scientific thought will allow to consider and, what is of particular importance, to decide similar questions in medical aspect also.
This is very important taking into consideration that the problem of delinquency increasing becomes more relevant day by day throughout the world in general and in Ukraine in particular. The base of that is a complex of factors, which formed a stratum of children deprived of parental care and attention. Violence escalation in our country is caused, on the one hand, by social and economic instability and mass unemployment,and on the other hand, by open advocacy of violence in mass media, literal, film and video products, and absence of age criteria for their consumers.
That is why the abovementioned social problem stepped out a family circle a long time ago, and it mostly concentrates at the level of judicial decision-making of offences and crimes. The world public actively raises problems of the asocial youth, ways of social rehabilitation, and delinquency prevention.
Delinquency rate causes concern and necessity to seek for its new preventive ways, state bodies and the public additional measure taking, which would promote crime decreasing among juveniles.
Finding out juvenile’s living and upbringing conditions, i.e. identification of his family and living conditions, contacts with other people etc, helps to define direct reasons, which forced a teenager to commit a crime, and to make conclusions whether the crime was accidental or it was caused by factors, which must be obviated.
It is well known that no one is born a delinquent, you should become one. Juvenile delinquents are formed by social conditions, in which they grow, and also by grown-ups who surround them. The base of behavior of juveniles, who breach the law, is their needs, and these needs are influenced by age, education and upbringing level, which grown-ups and society gave them.
Namely, needs guide juveniles to those objects and things, which bring them satisfaction and presence of which is necessary for their physical and spiritual existence. Needs of juvenile delinquents undergo deviations because of being below his schoolfellows in class, deficiency in upbringing, and inadequate development conditions.
Juvenile age characteristics considerably influence their actions motivation. Such characteristics are a brief life experience; an imitation tendency; an influence of other people, and grown-ups in particular; a desire to show himself independent and trying to avoid control and care of parents and teachers; a specific interpretation of such notions as courage, honesty, friendship; a wrong evaluation of life situations; an insufficient development, and sometimes an absolute absence of critical attitude to his own and others’ actions. It is necessary to take into consideration psychophysiological characteristics of personality formation and difficulty of the interim period from the childhood to the adult life.
A positive solving of delinquency problem can not be reduced to applying criminal measures. The desire to solve social and economic problems of the present Ukrainian society by the means of the criminal law will not lead to positive changes, and criminal, procedural and executive laws will hardly help to solve social and economic questions if they are not an addition to social and economic state reforms. Seeing characteristics of the child psycho-pedagogical development, and of juvenile delinquents in particular, working out psycho-pedagogical and medico-psychological profile of child influence in the context of juvenile justice implementation also becomes relevant.
This proves again that juvenile justice must have a complex character because not only court should be included in its bodies, but also centers of medico-rehabilitative and social-psychological aid, medico-social care etc.
In this context it is necessary to pay attention to the medical aspect of this problem, namely, to those factors, which form the portray of a future delinquent, i.e. thoughts, emotions, neuropsychological features etc.
Overwhelming majority of persons, who commit one of the most dangerous crimes against another person – sexual, has variable psychopathological personality changes. Such changes of juvenile delinquents increase due to adolescence characteristics. As MIA of Ukraine reports, about a half from more than thousand people, who are brought to trial for sexual crimes every year, is teenagers.
The most common type of psychopathy is epileptoid-instable (it should be mentioned that persons with such a psychopathy mainly play a key role in committing a crime). Combining epileptoid and instable identity radicals created maximum socially retarded personality, who did not accept any social rules and moral tabu, and are characterized by extremely easy change from the delinquent behavior to the criminal one. Sexuality of these teenagers was deformed, and committed crimes were the cruelest with the hardest consequences for victims.
Here is another aspect of the problem: analyzing seasonal clinical symptoms among schizoid patients on the base of Poltava state mental health clinic, dependence of manifestations, acute conditions, and also sexual crimes among examined patients on heliophysical factors was determined. In part, all the crimes committed by a schizoid occur in spring, i.e. at the period of the highest heliophysical instability (based on the article “Some Epidemiological Parameters of Male Schizoid Morbidity and Evaluation of Sexual Crimes among Them Depending on a Season” by Sonnyk Y. published in “Psychiatry and Medical Psychology Journal” № 1, 2000).
In these examples scientific publications, in which doctors and psychologists analyze delinquency problem, have appeared in medical periodicals in recent years.
Since 1997 the working experience of Kyiv scientific-methodological center of clinical ultrasound “Istyna” allowed to raise and to decide the problem of the medical supervision of patients with affect risk running out into unlawful actions, to prognosticate the danger of such a patient for the society and also to form own neuropsychological conception of a boy delinquent personality formation, which may be presented as follows.
1. On the base of higher brain centers immature, pedagogical neglect, juvenile emotive underdevelopment mental diseases may secondarily occur as disadaptation breakdown.
2. Examining juvenile personality, it is necessary to carry out not only deep researches of cognitive, emotional, behavioral disorders in the perspective of factual findings, but also thorough analysis of the pedagogical neglect role in the formation of a certain personality and childhood deep psychological traumas, which were not timely corrected with the help of psychotherapist.
3. Important starting mechanisms of committing a crime against a society with signs of the personal violence are hidden aggression, emotional dullness, inability to feel own body and express own thoughts, absence of understanding of either human feelings or own emotions, sympathizing, offence forgiveness, perception of somebody’s despair or woes.
4. An important factor is the absence of legislative acts on the parental responsibility for a possible delinquency of psychologically unbalanced children, the impunity of the pedagogical neglect, hypercare, and the unwillingness to educate own children. As the result such parents search a shelter for their children in psychiatric clinics. The next step is the state protection of mentally sick child rights and the impunity and permissiveness under the cover of the mental diagnosis (teenagers often know their rights, but they do not accept their own duties towards the society).
5. Such a teenager often gains “necessary” weight during puberty (it visually creates an image of weight predominance) on the base of non-functioning of satiation center and poliphagia, and sedentary life. Hidden aggression, obsessive weight (obesity), non-control of a power beat due to the obsessive weight and the absence of his own emotions balance complete the portray of an asocial personality at the stage of the crime debut.

Here is an example in practice.
Olexandr К., 27 years old, diagnosis: advanced residual infantile cerebral paralysis with moderately expressed bilateral pyramidal insufficiency, with hard motormental retardation and speech delay, cognitive development fits age of 3,5–4,5 secondary to the possible birth trauma, significant signs of arteriovenous-liquor intracranial imbalance with total ischemia of the brain tissue in average at the level of 40–50% systolic and 100% diastolic deficit, significant signs of disproportional disontogenesis of higher brain processes, and evident neurodynamic processes immature. Threatened psychopathy of immature brain.

Olexandr attended a medical appointment with his parents, who complained of son’s developmental delay, speech disorder, fears and irritation.
Admission psychological status was characterized by self-image disorder; disability to control personal impulses, absence of feeling differentiation, coldness in the emotional sphere. In part, Olexandr did not distinguish between right and wrong, he did not know how to thank or sympathize somebody. He had a consumer attitude to the world – he clearly knew what other people had to do for him, but he could not define his own duties towards them.
Two courses of the intensive medicamental neurorehabilitation with involving kinesitherapy, biorhythmocorrection, psychocorrection, and psychostimulation of the expressive speech, meridian correction with instrumental USG-control of cardiovascular, vascular-cerebral and motorkinesthetic systems by innovative methods of the team of the scientific center “Istyna” were carried out.
In the course of the treatment new problems were found: hidden aggression, which could be a result of misunderstanding of own feelings sense and possibilities of negative emotions catharsis, was accidentally revealed in a certain period during kinesitherapy with using a punchbag.
But the hardest trial for center specialists was the obsessional ipsation as a result of inability to change over, lack of contact sensations and positive impressions. Parents, by the way, believed that ipsation is a normal sexual function of his age.
In the dynamics of the integrated individually selected treatment aimed also at the boy’s social growth and his emotional development, considerable improvements were achieved.
• Neurological status: increase in cognitive functions, growing of muscle strength in left extremities and general sustaining power, in average one point up, decrease in pyramidal deficit intensity, and coordination improvement.

• Psychological status: formation of the positive self-image, feeling differentiation and their conformity to situations; flexibility of emotional sphere; skills of the social adaptation and social growth, empathy (ability to sympathize); attention fixity development; decrease in nervous tension; short-term aural memory extension; ideation development (analysis, synthesis, generalization etc); enlargement of the scope; development of the dynamic praxis; assertion rise.

Ipsation was almost disappeared, the need in it was overcome with the help of the tactual contact (positive support – for example, palmsing on the shoulder as a sign of encouragement for a well-done task) and receiving new impressions. Obsessive aggression was also obviated due to regular physical activity including various exercises and special psychocorrective trainings.
Activity of speech communication and pronunciation were also improved, elements of speech self-control were marked.

On the base of many years’ examinations of children with neurological diseases, being neurologist, cerebral vessel ultrasonographer and neurophysiologist, I suggested my own hypothesis on delinquency nature related to cerebral circulation characteristics and brain functions at the interim period.This hypothesis was first published in the article “Juvenile Crime from a Medical Perspective” of “Poradnytsya” newspaper from February, 18, 1999.
The point is that during the accelerative body growth (mostly at the age of 7-10 and 15-20) an organism considerably changes. At the age of 15-20 blood supply redistribution is strongly marked. A child has suddenly grown, but the heart has not enlarged, and since it starts to function worse. Let’s make an example: nobody will put a water pump, which is able to pump water only up to the first floor, if a building has three floors. If the body height increases by 10-15cm during half a year, and the heart does not acquire relevant sizes, blood supply deficit, including cerebral one, occurs. In case of adding different stress agents, catarrhal diseases or craniocerebral traumas the brain will undergo chronic edema.
Now let’s imagine size-stable brainpan and edematic brain, which does not have enough place to locate, that is again reflected on behavior. If this system can not keep stability during a juvenile’s growth, it should be corrected medicamentally. If it is not corrected, pathology will progress. Today we notice a child’s weakness, tomorrow - intellectual functioning debilitation, and after tomorrow we get a pathologic response to an external agent as the child can not control own emotions. When the brain edema apostasis develops, consciousness may be darkened, and then the child really does not understand what he does.
In our clinical practice we have often watched how a child, who undergoes the examination in our clinic, can not control his actions, his behavior is invariable, and it is even difficult to place the child on the couch for diagnostic ultrasound. But after the course of medicamental treatment, in a month, when the same child attends us for the control checkup, we see that he greets center workers and does everything he is asked, place himself on the couch and even helps to put probes. So, his behavior became congruent. But is it possible to rectify in a month?
If a child does not know behavioral norms, at the level of every day life most people will decide that parents did not pay an adequate attention to his upbringing. Our experience proves that behavioral norms were often instilled by parents, but the child’s brain was not ready to an adequate perception of irritants.
An example may be Sergiiko S. of six years old. Diagnosis – motormental retardation with elements of hyperactivity. Parents complained that the boy was extremely excited, nervous, and he has a firm fear of everything unknown. Sergiiko was examined and the treatment aimed at improvement of cerebral blood supply was prescribed. After a month’s course of treatment the first positive changes were marked: it was possible to speak to him and go out with him. Then according to the results of the control checkup the treatment was corrected, logopedist and psychologist trainings were added. The treatment was long-term as the disease was serious. In the result of the intensive neurorehabilitation normalization of the psychoneurological status and the full child’s social growth were achieved.
Every treatment method has a certain pathogenic base. Analyzing behavior of sick children of different age, we revealed signs of brain edema and intracranial pressure increase. If brain edema develops, the brain structure changes. Brain is very sensitive, and as soon as fluid starts accumulate in the brainpan, it absorbs this fluid like a sponge, hence, it can not function properly.
Brainpan contents must be stable because skull bones can not be extended. Everything in it must be located freely. And this means that the content of brain, blood, and liquor (cerebrospinal fluid) must be also stable. If only one of these parameters increases, others have to decrease as there is no reserve of an extra space.
We noticed that if a child has signs of brain edema or increased intracranial pressure, his behavior becomes invariable.
Consequently, we approach the aggression phenomenon and children’s emotional lability (instability) explanation. It should be mentioned that their brain has especially strong ability to accumulate the fluid, and the slightest craniocerebral trauma or a stress may lead to unpleasant outcomes.
A simplified explanation is: processes of excitation and inhibition in the normal tranquil brain are balanced. But when the brain is edematic, its sensitivity increases, and instead of one normal impulse it receives tens of them, that is why the brain may fail while analyzing these impulses. Moreover, a child in contrast to an adult person is not well oriented in many things and can not inhibit these processes on his own as his cerebral cortex is underdeveloped.
Supervising such aggressive children and changes in their behavior during the course of their treatment, when blood circulation and intracranial pressure parameters were more or less stabilized, signs of brain edema decreased, we noticed that our little patients changed in their character. Hence, the conclusion is: cerebral pathology triggers behavioral pathology. The connection between them is evident.
To the point, developing this idea, one may come to an interesting conclusion that delinquency and invariable behavior are not something organically typical of a human being, but diseased manifestations. It stands to reason that this idea is controversial and requires studying and researching.
It is also necessary to change the attitude of the society to people, who served a sentence. If a teenager committed a crime, even when he sincerely wants to get back to his normal life, now he is often considered as a lost person for the society, people turn their faces away from a boy delinquent at the time when he needs support.
In this way the vicious circle builds. To break it, we need to enter the necessary level of this problem research. The problem of delinquency requires the integrated approach on the nationwide scale based on close cooperation of law enforcement bodies, youth social service and medical institutions. It is necessary to work out a common nationwide program and to lead thorough, detailed medical trials of juveniles, who serve a sentence, within this program, and later – their treatment. Specialists of our center worked out the individually oriented medical diagnostics and treatment methods of such patients from the risk group, which is accordingly patented. The results may be unexpected. If such a program is carried out, finances invested in it will be soon paid off, and the criminogenic situation will improve.
Scientific medical center “Istyna” on the base of the integrated examination and, if needed, family consultations could deliver necessary medical care to juveniles with invariable behavior and signs of aggression, and their families, leading the appropriate medical expertise and offering the integrated individually selected treatment in every separate case, and, where applicable, be an independent expert.
Considering this problem, we should remember that juveniles behavior largely influence not only the present day, but tomorrow also. Today we create a foundation for Ukraine’s future.

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